title: Risk factors for requiring extracorporeal membrane oxygenation support after a Norwood operation.
abstract: BACKGROUND
  Patients requiring extracorporeal membrane oxygenation (ECMO) support after a Norwood operation constitute an extremely high-risk group. Data regarding risk factors for the requirement for ECMO post-Norwood are limited, however. We retrospectively assessed risk factors for requiring ECMO support after a Norwood operation during a 10-year period in a high-volume center.
  
  
  METHODS
  Retrospective case-control study of 64 consecutive patients requiring ECMO support after a Norwood operation at a single institution during a 10-year period (January 2001-December 2010), with a 3:1 era-matched control group of patients who underwent a Norwood but did not require ECMO.
  
  
  RESULTS
  In univariate analysis, ascending aorta less than 2.0 mm, longer cardiopulmonary bypass (CPB) time, intraoperative shunt revision, and right ventricle to pulmonary artery conduit were associated with the need for postoperative ECMO. A single left ventricle was protective compared with single right ventricle anatomy. By multivariate logistic regression, birth weight less than 2.5 kg and longer CPB time were independently associated with the need for postoperative ECMO. Receiver-operating characteristic curve analysis identified a peak lactate of 9 mmol/L and a peak vasoactive inotrope score (VIS) of 27 within 48 hours of surgery as most prognostic of the need for ECMO.
  
  
  CONCLUSIONS
  Birth weight less than 2.5 kg and longer CPB time are independently associated with the need for ECMO after a Norwood operation. Peak serum lactate and peak VIS may be useful in stratifying risk for ECMO. Risk factors for ECMO post-Norwood appear to be similar to the risk factors for early mortality post-Norwood.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics and Communicable Disease, University of Michigan, Ann Arbor, Mich. Electronic address: jmfriedl@med.umich.edu.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Friedland-Little
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics and Communicable Disease, University of Michigan, Ann Arbor, Mich; Section of Pediatric Cardiac Surgery, Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Hirsch-Romano
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics and Communicable Disease, University of Michigan, Ann Arbor, Mich.
authors.forename: Sunkyung
authors.initials: S
authors.lastname: Yu
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics and Communicable Disease, University of Michigan, Ann Arbor, Mich.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Donohue
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics and Communicable Disease, University of Michigan, Ann Arbor, Mich.
authors.forename: Courtney E
authors.initials: CE
authors.lastname: Canada
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics and Communicable Disease, University of Michigan, Ann Arbor, Mich.
authors.forename: Parisa
authors.initials: P
authors.lastname: Soraya
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics and Communicable Disease, University of Michigan, Ann Arbor, Mich.
authors.forename: Ranjit
authors.initials: R
authors.lastname: Aiyagari
mesh_terms: D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D001724:Birth Weight; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D016009:Chi-Square Distribution; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D061847:Hospitals, High-Volume; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D019344:Lactic Acid / Q000097:blood; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D058327:Norwood Procedures / Q000009:adverse effects* / Q000401:mortality; D016017:Odds Ratio; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D019344:Lactic Acid